The nurse should describe pain that is causing the client a “burning sensation in the epigastric re-gion” as: 1. Referred 2. Radiating 3. Deep or visceral 4. Superficial or cutaneous ANSWER ANS: 3 Deep or visceral pain is diffuse and may radiate in several directions. Visceral pain may be de-scribed as a burning sensation. […]
The nurse is assisting in logrolling a client recovering from spinal surgery. Why should the nurse place a pillow between the client’s legs when turning? 1. Stabilizes the spine 2. Prevents hip contractures 3. Supports the upper leg 4. Keeps the legs parallel and aligned 5. Prevents adduction of the upper leg ANSWER Correct […]
The nurse realizes that the cancer support group for breast cancer clients will be most effective if the group: (Select all that apply.) 1. Is not too large 2. Is similar in age 3. Members feel valued 4. Communicates freely 5. Shares a common culture 6. Meets in a comfortable place ANSWER ANS: 1, […]
A client has severe right-sided weakness and is unable to complete bathing and grooming inde-pendently. Based on this observation, the nurse identifies a nursing diagnosis of: 1. Powerlessness 2. Self-care deficit 3. Tissue integrity impairment 4. Knowledge deficit of hygiene practices ANSWER ANS: 2 The client who is unable to complete bathing and grooming […]
A 25-year-old client’s wife complains to the nurse that he sleepwalks during the night. The nurse knows that this behavior normally occurs in which stage of sleep? 1. Stage 2: NREM 2. Stage 3: NREM 3. Stage 4: NREM 4. REM ANSWER ANS: 3 Stage 4 NREM sleep is the deepest stage of sleep. […]
If the RN has several LPNs on the shift to supervise, which of the following responsibilities will fall to the RN? 1. Evaluating the care provided to the client. 2. Administering intramuscular (IM) medications. 3. Performing dressing changes. 4. Delegating appropriate tasks to unlicensed client care providers (such as a nurse’s aide). ANSWER Correct […]
Which of the following statements made by ancillary personnel regarding the bathing of a 79-year-old client requires immediate follow-up by the nurse? 1. “At times you have to really work at getting her to agree to having a bath.” 2. “I learned that an evening bath is what she is used to, so I’ll bathe […]
Which of the following clients should be prioritized with the most urgent need for a nursing as-sessment? 1. A new admission admitted for swelling in the right ankle and knee 2. A second day postoperative client who received pain medication 30 minutes ago 3. A client who the nursing assistant found crying in the bathroom […]
A client has a prescription for a medication that is administered via an inhaler. To determine if the client requires a spacer for the inhaler, the nurse will determine the: 1. Dosage of medication required 2. Coordination of the client 3. Schedule of administration 4. Use of a dry powder inhaler ANSWER ANS: 2 […]
The nurse is caring for a client with type 1 diabetes who has been diagnosed with end-stage renal disease (ESRD). The nurse regularly assesses the client for which of the following? (Select all that apply.) 1. Nausea 2. Polyuria 3. Lethargy 4. Vomiting 5. Confusion 6. Headache ANSWER ANS: 1, 3, 4, 5, 6 […]
